Provider Demographics
NPI:1386002871
Name:ROTTIER, KAREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:ROTTIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 W OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4010
Mailing Address - Country:US
Mailing Address - Phone:773-394-4807
Mailing Address - Fax:773-394-4697
Practice Address - Street 1:1539 W OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4010
Practice Address - Country:US
Practice Address - Phone:773-394-4807
Practice Address - Fax:773-394-4697
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007189103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist